PHQ-2 — depression ultra-short screen
The two-question version of PHQ-9 (Kroenke, Spitzer, Williams, 2003). Used in primary-care offices worldwide as the first step of the standard depression workup. A positive PHQ-2 is the trigger to administer the full 9-question PHQ-9 — it isn't a diagnosis, it's a checkpoint.
PHQ-2 takes about 60 seconds, scores 0–6, and uses cutoff ≥3 for a positive screen (sensitivity 83%, specificity 92% for major depression — Kroenke 2003). A positive screen does NOT diagnose depression. It means you should complete the full PHQ-9 next. Both instruments are public-domain and were designed for use without a clinician.
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Below cutoff (≥3). Major depression unlikely. If you still feel something is off — pay attention to it. Mood symptoms can fluctuate; consider re-screening in 2–4 weeks if concerns persist, or talk to your doctor.
A positive PHQ-2 means a more thorough evaluation is warranted. This is information, not a diagnosis. The standard next step is the full 9-question PHQ-9, which gives a severity band and asks specifically about suicidal ideation. After that, a primary-care or behavioral-health clinician can confirm or rule out depression.
Where PHQ-2 came from and why it works
The Patient Health Questionnaire-2 was published in 2003 by Kurt Kroenke, Robert Spitzer, and Janet Williams as the ultra-short version of their earlier PHQ-9 instrument. The two items represent the two cardinal symptoms of major depressive disorder per DSM-IV-TR (and DSM-5): depressed mood and anhedonia (loss of interest or pleasure). Endorsement of either, persistently, is the diagnostic gate for major depression.
In their validation study (Kroenke et al., 2003, Medical Care), the authors administered PHQ-2 to over 6,000 patients in eight primary-care clinics and used a structured clinical interview as the gold standard. At a cutoff of 3 or higher (out of 6), PHQ-2 had a sensitivity of 83% and specificity of 92% for major depressive disorder. That trade-off — high sensitivity, very high specificity — makes PHQ-2 ideal as the FIRST screen in a two-step workflow: catch the people who probably have depression while not over-flagging healthy patients.
How clinicians actually use it
The standard primary-care workflow is: (1) PHQ-2 administered at every routine visit → (2) if positive (≥3), administer PHQ-9 same visit → (3) PHQ-9 score guides severity-based action (watch-and-wait for mild, therapy referral for moderate, antidepressant + therapy for moderate-severe, urgent care for severe-with-suicidality). This stepwise approach is endorsed by USPSTF (B-grade), AAFP, AAP, and the VA/DoD clinical practice guideline.
When NOT to use PHQ-2
- If you already know you have depression and want to track severity → use PHQ-9 directly (PHQ-2 doesn't give a severity band).
- If you're worried about anxiety primarily → use GAD-7 instead. Mood and anxiety often co-occur, but GAD-7 catches anxiety better.
- If you're in active crisis → don't take a quiz, call 988. Self-tests aren't designed for acute safety triage.
- If you've recently had a major bereavement → grief and depression overlap, and PHQ-2 doesn't distinguish them. A clinician interview is more appropriate.
PHQ-2 alongside addiction screening
Co-occurring depression and substance-use disorder is the rule, not the exception — population studies put the comorbidity rate at 30–40% of people with either condition. That's why SBIRT (Screening, Brief Intervention, Referral to Treatment) — the SAMHSA primary-care framework — pairs an alcohol screener (typically AUDIT-10 or CAGE) with PHQ-2 or PHQ-9. If you took PHQ-2 because of an alcohol or drug concern, the right pair is PHQ-2 + AUDIT-C (or AUDIT-10) together.
Quick definitions
FAQ
What does a positive PHQ-2 mean?
A score of 3 or higher (out of 6) is considered a positive screen. Sensitivity for major depression at this cutoff is 83%, with specificity of 92% (Kroenke et al. 2003). A positive PHQ-2 is the standard trigger to administer the full 9-question PHQ-9 — it does not by itself diagnose depression.
Difference between PHQ-2 and PHQ-9?
PHQ-2 contains the first two items of PHQ-9 (depressed mood and anhedonia). It takes under a minute and is used as the initial screen. If positive, the full 9-question PHQ-9 (3–5 minutes) is administered for severity grading and clinical decision-making, including a specific suicidal-ideation item.
Is PHQ-2 USPSTF-recommended?
Yes. The U.S. Preventive Services Task Force recommends depression screening for all adults in primary care (B-grade recommendation, 2023 update). PHQ-2 is the most widely used ultra-short instrument for this initial step.
Is PHQ-2 free to use?
Yes. PHQ-2 is in the public domain and reproduced with permission per phqscreeners.com. No license fee or registration required.
What if my score is high?
A score ≥3 is the standard threshold for a positive screen. The next step is the full PHQ-9, which gives a severity band and asks specifically about suicidal ideation. If you're in crisis right now, call or text 988.
Sources
- Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care. 2003;41(11):1284–1292.
- PHQ Screeners — public-domain instrument distribution (Pfizer Inc., reproduced with permission).
- U.S. Preventive Services Task Force. Depression and Suicide Risk in Adults: Screening (2023, B-grade).
- SAMHSA — Screening, Brief Intervention, and Referral to Treatment (SBIRT).
Other validated screeners
AUDIT-10 (Alcohol Use Disorders Identification Test)
10-question WHO-validated alcohol screener. Pair with PHQ-9 for a full alcohol-plus-depression picture — the combination is the standard primary-care SBIRT workflow.
DAST-10 (Drug Abuse Screening Test)
10-question Skinner-1982 drug-use screener (excluding alcohol and tobacco). Pair with PHQ-9 if substance use other than alcohol is a concern.
PHQ-9 (Patient Health Questionnaire-9)
9-question Kroenke-2001 depression severity screener. Depression co-occurs with substance use disorder in 30–40% of cases — integrated treatment is best evidence.
GAD-7 (Generalized Anxiety Disorder)
7-question anxiety severity screener (Spitzer 2006 — same author family as PHQ-9). Anxiety co-occurs with depression in roughly 50% of cases. At cutoff ≥10: 89% sensitivity, 82% specificity for GAD.
CAGE-4
4-question alcohol screener (Ewing JAMA 1984). Faster than AUDIT-10 but less sensitive. Public-domain. Cutoff ≥2 has 71% sensitivity / 90% specificity for AUD.
ACE (Adverse Childhood Experiences)
10-question retrospective measure of childhood adversity (Felitti / CDC 1998). Public-domain. ACE ≥4 increases adult substance use disorder risk by 7×. Trauma-informed counterpart to current-symptom screeners.
PCL-5 (PTSD Checklist for DSM-5)
20-question current-symptom screener developed by VA National Center for PTSD (Weathers 2013). Public-domain. DSM-5-aligned with 4 cluster sub-scores. Pairs with ACE (past exposure + current symptoms = standard trauma workup). Cutoff ≥31 for probable PTSD.
WHO ASSIST
Longer 8-item WHO instrument covering alcohol, tobacco, cannabis, cocaine, stimulants, inhalants, sedatives, hallucinogens, opioids. For one-shot multi-substance screening. WHO ASSIST manual.
